HomeMy WebLinkAbout2017-00112 - addn/remodel/repair , . CITY O ORONO * 2 0 1 7 - 0 0 1 1 2 *
2750 KELL Y PARKWAY DATE ISSUED: 02/13/2017
ORONO MN 55356-
(952)249-4600 F : (952)249-4616
ADDRESS : 2500 SHADYWOOD RD
PIN : 20-117-23-11-0034
LEGAL DESC : REG.LAND SURVEY NO. 163'0
: LOT 000 BLOCK 000
PERMIT TYPE : ADDITION/REMODEL/REPAIR
PROPERTY TYPE : COMMERCIAL-BUSINESS
CONSTRUCTION TYPE : ADDN/REMODEL/REPAIR
ACTIVITY : 437-NONRESIDENTIAL&NaNHOUSEKEEPIN
VALUATION : $ 20,000.00
NOTE: SEPARATE PERMITS REQUIRED: PLUMBING,MECHANI�AL,ELECTRICAL(STATE)
INERIOR REMODEL FOR SUITES#410 AND#420 I
APPLICANT pERMIT FEE SCHEDULE 356.22
Ugorets 8098 LLC STATE SURCHARGE(VALUATION) 10.00
410 11TH AVE S TOTAL 366.22
HOPKINS,MN 55343- Payment(s)
(952)769-7249 CHECK 1601 366.22
OWNER
Ugorets 8098 LLC
410 11TH AVE S
HOPKINS,MN 55343-
AGREEMENT AND SWORN STATEMENT
The work for which this pertnit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming this rype of work
shall be compied with whether or not specified hereia This permit will
expire and become null and void if construction suthorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring alI required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. ��
(� � ��-�-- a/►3/� �°-��� �-� �3 � ��
Applicant Permitee Signature Date Issued B ignature Date
Z R
, , �� ���!.�
CITY �F ORONO � ��Qb FEB � 7��(7
BUILDING PE MIT APPLICATION CI'nr oF oRONo
FOR NEW STRUC URES OR ADDITIONS
�Q A T Mailing Address: Permit number. c�L�I7- �O/l
`VO PO BOx 66
Crystal Bay, MN 5323-0066 Date received: ��7'��
� ,, StreetAddress:'
Received by:
y� G.� 2750 Kelley Parkv�ay 1 0'�� Plan review fee: ��• 5
�9k�SH���C Orono, MN 55356 �1� o�j7-p p!�/
Main: 952-249-4600 , Total Fee:
Fax: 952-249-4616 ' www.ci.orono.mn.us
This application forrn`musf be completed in ull and ail required information must be submitted.
Incomplete applications will be returned. (Please print) 5�;},Qs y�a�-y�lC
GENERAL INFORMATION: ,
Job Site Address: y -}� - a SGG S ho..d, wcc_,� "�,.
Will this be a Parade of Homes, Remodelers Showc�se Home or other Display Home? es No
If yes,a special event permit is required with Police Department and Cit Council approval 60 days prior to the event. Shuttle bus service will be
required un/ess applicant demonstrates su�cient on-site parking is avail b/e. Non-permitted events will not be a/lowed.
CONTRACTOR/APPLICANT INFORMATION:
Name:
State License# Expiration Date: '
Phone: cell (r,�� - - 3 � office
Mailing Address: y�0 "' A��, � Cit : k,nz ZIP: ,j'3'
Contact Person: R c - Applicant is: Contract / Homeowner (Circle One)
Email and/or Fax: � - �
PROPERTY OWNER INFORMATION:
Name: l��cr�s 8c�I$ �. L.C .
Phone(day): (�a_ 3�3 -3 3d 1 ,
Address: y �� 11''" .,. Cit : o , ZIP: sS y3
Email and/or Fax �.,\� �p �„„dk,���as ,,�
ARCHITECT I ENGINEER INFORMATION:
Name: �.� -,,} s �
Phone(day): ci�,� _ �y� _ g��,D
Address: 1�1; }►. pp Cit : ZIP:
Email and/or Fax: ;� f �,,�
PROJECT INFORMATION: Description of pro'ect:
1.Type of Project 2. Proposed Use 3.Structure Type 4.Sewage Disposal 8
❑New Construction Water Supply
❑ Single Family th ❑Accessory Bldg./Garage
❑Addition attached gara e ❑ Deck
❑Accessory Building ❑ Sin le Famil ith �Public Sewer
g y �Office/Commercial
❑ Relocation detached gara e ❑ Residence ❑ Private Sewer
�,Other:(specify) R�mn�� ❑ Multiple Family Condo ❑ Retaining Wall(s)
❑ Public 4-feet or greater ,g(Public Water
*`Any earth movement may atso require �Commercial ❑Storage
MCWD review 8 permits. ❑ Industrial ❑Warehouse ❑ Private Well
Minnehaha Creek Watershed District(MCWD) ❑Other:(SpeCify) ❑Other(SpeCify)
15320 Minnetonka Blvd
Minnetonka,MN 55345
Phone: 952-471-0590
Fax: 952-471-0682
www.mi nnehahacreek.or
Estimated Construction Valuation (excluding land) $ �C,j _ Qtg� , (��
Last Updated: January 2016
� �
STRUCTURE INFORMATION:
1.Structure Dimensions 1. Structure Dimensions(continued)
a. Length(ft.)= Number of bedrooms= 2. Occupancy:
b.Width(ft.)= Number of garage stalis:
3. Occupant Load:
Areas in square feet Attached =
Ch��^\ s-h,�-L�
c. Basement= Detached = 4. Type of Construction: <.�h��s� �=
d. 1 S�Story =
e.2"d Story= 1 S� ,*}- 5. Code Edition:
f. '/z Story =
g.Total Area=
REQUIRED SUBMITTALS:
All of the information must be submitted in order for your application to be processed:
Not
Enclosed Applicable
❑ Building Permit Escrow Agreement and Fees
❑ Plan Review Fee
� ❑ Completed Application Form
❑ Pro osed Buildin Plans—2 full size sets,to scale and 1 reduced 11 x 17 or 8'/�x 11 set
� � Minnesota State Ener Code Calculations and Mechanical Code Re uirements
� ksl Survey—2 full size,to scale(meetin ALL survey requirements
� Hardcover Calculations
� �Sl Septic S stem Certification
� � Minnehaha Creek Watershed District(MCWD)Permit or
Documentation from MCWD statin no ermit is re uired
� ,$1 Landscape Walls and/or Retainin Wall Plans
� � Stormwater Pollution Prevention Plan SWPPP
� � Access Permit
� ❑ Data Privacy Advisory Form
APPLICANT/OWNER ACKNOWLEDGEMENT:
• Agrees to provide all information required or requested by the Building Department;
• Agrees to pay the City of Orono for engineering consultant review costs in excess of$500;
• Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they are
solely responsible for submitting a complete application being aware that upon failure to do so, the staff has no alternative but to
reject it until it is complete;
• Acknowledges the Escrow Agreement is completed and signed;
• Understands some or all of the information that you are asked to provide on this application is classified by State law as either
private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject of
the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our
purpose and intended use of this information is to annually update our records and records of other governmental agencies
required by law. If you refuse to supply the information, the application may not be issued.
• Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the
Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000
escrow to ensure co letion of the as-b 'It survey and all site improvements.
ApplicanYs Signature: Date: � i
Owner's Signature: t� Date: f
Last Updated: Janua 01
, .
Permit Application: Self-Checklist for Completeness
Please note, the applicant must initial in the boxes below to acknowledge the minimum required
information is included with the submittal. If not, the application will NOT be accepted Call
952.249.4620 to schedule a meeting with staff if you have questions on application submittal
requirements.
Completed Application
Plan Review Fee Paid
�� Signed Escrow Agreement & Escrow Payment
�1 Building Plans (to scale) x2
__ Certificate of Survey (to scale) showing the proposed project &
meeting all requirements x2
_- - Hardcover Calculations (if applicable)
I am aware that Orono will not issue a building permit without a
copy of MCWD permits (or documentation from the MCWD stating
the proposed project does not trigger their permitting
requirements). I will contact the MCWD at 952-471-0590
reg ' g this proj ct �
,-
Signed by: L��
Address: o�`�� ��Q �pe �� � �p a �
Permit #: _ �p /�-Od / /
Last Updated: January 2016
, PLAN REVIEW CHECKLIST FOR NEW STRU��RES / ADDITIONS
Address: �`�(�� .Sl�,o'YW�� Sv��l"eS�r j�� �Permit No.: �r�/�` (�0(� 2-
Description of work: Date Rec'd:
Se tic review b `��!(.(/�Cl�' `� � � Se`�` � �t������'` �`�`� l.� ��,
p y: � a �°l� Date Approved:
Zoning review by: Date Approved:
Building review by: Date Approved: �� �
Grading review by: Date Approved:
Zoning District: Zoning File#: Reso#: Reso Date:
Zoning: Lot Area: SF/AC Width: Lot Coverage: SF %
Survey Submitted: � Yes � No Date of Survey: Revised date(?):
Landscape plan submitted? 0 Yes ❑ No Landscaper:
Proposed Setbacks:
Front(Lake) Rear(Street) ( N S E W ) ( N S E W ) Other Buildings Wetland
Side Side
Defined Height: Peak Height: FFE: FFE minus 6 feet= (Existing Contour)
Perimeter(linear feet) = 50°/a = L.F. below grade
Basement? 0 Yes 0 No, Stories
FOR A BUILDING WITH A BASEMENT OR CRAWL SPACE: FOR A BUILDING ON A SLAB FOUNDATION:
The distance between the lowest proposed Slab at or above grade—
START WITH floor(of the basement or crawl space)and measure from hiahest existina
the highest point of the roof. START WITH rp ade to the highest point of the
roof even if fill was brought in to
elevate home.
If you have a...
SUBTRACTION • GABLE OR HIPPED ROOF(no Slab below grade—measure
(BASED ON windows): Subtract half the distance from highest existing grade to the
ROOF TYPE) between the highest point of the roof hi hest oint of the roof.
to the low point of the corresponding If you have a...
gable or hipped roof SUBTRACTION ' GABLE OR HIPPED ROOF
• GABLE OR HIPPED ROOF(with (BASED ON (no windows): Subtract half
windows): Subtract half the distance ROOF TYPE) the distance between the
between the top of the highest highest point of the roof to
window and the highest point of the the low point of the
roof corresponding gable or
hipped roof
• ALL OTHER ROOF TYPES(flat, . GABLE OR HIPPED ROOF
mansard,etc):No subtraction. (with windows): Subtract
SUBTRACTION Subtract the distance between the half the distance between
(BASED ON basemenUcrawl space floor and the the top of the highest
EXISTING highest existing grade adjacent to the window and the highest
GRADES) foundation OR 10 feet(whichever is less). point of the roof
• ALL OTHER ROOF TYPES
(flat,mansard,etc):No
EQUALS Defined building height subtraction.
Defined building height
EQUALS
Updated: October 2015
z:\forms\plan review checklist 10-2015.docx I
Shoreland District MCWD Permit Average Lakeshore Setback Bluff
Met?
0 Yes p No Permit Number: � Yes 0 No � N/A � Ye No �
� N/A—see attached Setback:
Stormwater Quality Existing Proposed
Overlay District Tier Hardcover Hardcover Variance Required CUP Required
circle one % and sf % and sf
0 Yes 0 No � Yes 0 No
1 2 3 4 5 Type(s): Type(s):
Fees to be Char ed YES NO
Perm it
Plan Review ". �'`
State Surcharge l/'
Investigation Fee V'
SAC—Number of SAC Units (�
Other(specify) �/'
Square Footage $ per Square Footage
Basement X = $
1 S' Floor X = $
2nd FIOOr X = $
Garage X = $
Estimated Construction Value: $ � �%, �(it/
Orono Inspections Required Work Requiring Separate Permits
� Footing � Site Plumbing � Grading/Filling
0 Poured Wall 0 Silt Fence/Erosion Control Mechanical � Fire
0 Foundation Survey 0 Hardcover Removal 0 Septic ❑ Water Connection
0 Foundation Waterproofing 0 Other(specify) 0 Fireplace ❑ Sewer Connection
Framing 0 Masonry 0 Lawn Irrigation
Insulation 0 Mfg. ❑ Landscaping
0 As-Built Survey 0 Other(specify)
�Final
� Lathe Required State Permits
0 Other(specify)
0 Well Electrical
�
c
REMARKS (in-house):
OFFICIAL REMARKS -TO BE NOTED ON PERMIT AND INITIALLED:
� See Builder Acknowledgement Form
� Prior to release of escrow money an as-built survey and hardcover calculations must be submitted and approved.
Updated: October 2015
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HOPKINS.MN 553C1
- .. '�.� � PHONE:61]1363-3331
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